Obturo-muco-retractor

ABSTRACT

AN INSTRUMENT FOR PROTOLOGICAL OPERATIONS COMPRISING A CYLINDER WITH TAPERED TIP AND CONCAVE BASE SECURED TO A HANDLED SHAFT DISPOSED AXIALLY THROUGH THE BASE, A CONCAVE CLOSURE MEMBER SLIDABLY MOUNTD ON THE SHAFT WITH ITS CONCAVITY FACING THE CYLINDER CAVITY, A WING NUT THREADED ON THE SHAFT BETWEEN THE CLOSURE MEMBER AND THE HANDLE, AND A COIL SPRING DISPOSED AROUND THE SHAFT BETWEEN THE WING NUT AND THE CLOSURE MEMBER, WITH THE LATTER ADAPTED TO BE URGED AGAINST THE CYLINDER BY ROTATION OF THE WING NUT.

Feb. 16, '1971 R. J. TJONG-JOE-WAI 3,554,532

OBTURO-MUCO-RETRACTOR Filed Aug.- 11, 1969 2 sheets-sheet 1 INVILN'I UR. flan (-54 J ZONGW/GILM' United States Patent 3,564,582 OBTURO-MUCO-RETRACTOR Richenel J. Tjong-Joe-Wai, 'Cornelis Jong Baw Straat 16, Paramaribo, Surinam Filed Aug. 11, 1969, Ser. No. 849,004 Int. Cl. A61b 17/00, 17/11 US. Cl. 128-346 7 Claims ABSTRACT OF THE DISCLOSURE This invention relates to the field of surgery and has for its objective the provision of an instrument for the performance of various types of proctological operations, such as radical hemorrhoidectomies, removal of anal fistulae and fissures, in Hirschsprungs disease, correction of prolapsis and in cancer of the lower half of the rectrum, by closed method, in which a pull-through operation can be performed without Opening the bowel. The instrument is so constructed and utilized that the anus remains closed during the performance of the operation, minimizing contamination, and the operative field drawn, by traction applied to the handle of the instrument, far above the normal surface, so that the operation can be carried out more easily without retractors, because of better access to the area, and nearly without bleeding so that no artery clamps are necessary and no sutures needed, hence no catgut or silk in the wound.

In the present state of the art, particularly where the affected or diseased area is well within the rectum, operations are performed internally at the normal area of the diseased membrane or tissue. The operating wound is thereby exposed to contact by germs, retractors and artery clamps are necessary, profuse bleeding may occur, requiring blood transfusions, the affected area is difficult to reach and the possibility exists that some portion of the aifected area may be missed.

The aforementioned difficulties and disadvantages are obviated by the present invention, which provides means for closing the anus during the operation and for drawing the operative field far above its normal location, thereby exposing it to easier access. The additional advantages secured by its use include almost 100% sterility, reduction in bleeding and therefore no post-operative bleeders or hematoma formation, elimination of the necessity for ligation of bleeding vessels and of rectum stricture.

It is therefore the principal object of my invention to provide an obturo-muco-retractor instrument for the performance of proctological operations which is adapted to close off the anus during the operative procedure and thereby eliminate the possibility of contamination,

A second important object of my invention lies in the provision of an obturo-muco-retractor by means of which the diseased area within the rectum is partially secured within the instrument and, by traction, drawn above its normal surface so as to be easily accessible for the necessary surgery.

3,564,582 Patented Feb. 16, 1971 "ice A third important object of my invention lies in the provision of an obturo-muco-retractor whose structure presents a suitable base for incising and suturing.

These and other salient objects, advantages and functional features of my invention, together with the novel features of construction, composition and arrangement of parts, will be more readily apparent from an examination of the following description, taken with the accompanying drawings, wherein:

FIG. 1 is a side perspective view of a preferred embodiment of my invention;

FIG. 2 is an enlarged side view of the embodiment of FIG. 1, partly in cross-section, showing the instrument closed;

FIG, 3 is a view similar to FIG. 2, but showing the instrument open;

FIG. 4 is a cross-sectional view, taken on lines 4-4 of FIG. 3; and

FIGS. 5-8 are diagrammatic views showing the instrument employed in the various stages of the operative procedure, in respect to a human rectum, of an hemorrhoidectomy.

Similar reference characters designate similar parts throughout the different views:

Illustrative of the embodiment shown, my obturomuco-retractor 10* comprises an elongated cylindrical body member 12 provided with a conical tip at its free end and having a cavity or recess 14 in its base 16, together with a shaft or rod 18 fixedly secured to the body member 12 by being screwed into an axial threaded bore in the body member 12 which opens into the cavity 14. The free end of the shaft 18 is provided with an integral cross-arm or handle 20. A cover or obturator 22 is slidably mounted on the shaft 18 between the body member 12 and the handle 20, and is provided with a cavity or recess 24 which is disposed facing the cavity 14 in the body member 12. The outer diameters of the body member 12 and the obturator 22 are identical, as are the diameters of the respective cavities 14 and 24, so as to provide respective rims 26 and 28 of identical thickness for the body member 12 and obturator 22, and a precision fit of the two when they abut one another, as shown in FIG. 2, whereby cavities 14 and 24 come into registry to form a single cavity, as shown.

Between the obturator 22 and the handle 20 the shaft 18 is provided with an external thread 30, which engages the internal thread 32 of a wing nut 34 mounted on the shaft 18, and a strong coil spring 36 is disposed around the shaft 18 with one end abutting the back of the obturator 22 and the other end abutting the wing nut 34, so that rotation of the wing nut 34 in the direction of the body member 12 forces the obturator 22 against the body member base 16 With a springy pressure, and rotation of the wing nut 34 in the opposite direction frees the obturator 22 from such engagement, as shown by FIG. 3.

The surfaces 3-8 and 40 of the respective rims 26 and 28 are provided with uneven surfaces, preferably grooved or ridged, as shown in FIG. 4, so as to provide additional friction against movement of any material caught thereinbetween by the pressure of the obturator 22 against the body member 12, and prevent slipping, as will hereinafter be described.

Finally, a cotter pin 42, or the like, is provided secured in an opening in the handle 20, by which the instrument may be suspended in an instrument cabinet or the like, or removed from a sterilizing cabinet.

My obturo-muco-retractor 10 is useful with many types of proctological operations, as has previously been mentioned. I will now describe the method of its use in a radical hemorrhoidectomy, referring to FIGS. -8 of the drawings.

Approximately on Hiltons line a curved needle with silk thread 54 is inserted, withdrawn, reinserted, etc., in the submucosa, going antero-posterior, like a cerclagesuture, as shown in FIG. 5. The obturo-muco-retractor is then inserted into the rectum and the silk thread 54 is drawn snugly against the body member 12 and tied firmly. With a rotating movement the obturator 22 is screwed against the body member 12 'While slight traction is applied simultaneously to prevent squeezing of the sphincter between them. Part of the internal hemorrhoids 52 are now within the cavity 14, part are pressed between the rims 26 and 28 and the most oral part lies on the outer aspect of the body member 12. The external hemorrhoids 56 are partly in the cavity 24, are partly squeezed between the rims 26 and 28, and lie partly outside of the instrument on the outer aspect of the obturator 22.

A section of the skin 44 now lies between the body member 12 and the obturator 22 and the anus is completely covered, as shown in FIG. 7. The operating area and the visible part of the obturo-muco-retractor 10 are disinfected again and a sheet with a hole is draped over it, making the operating area much smaller. The skin of the anal canal which lies around the obturator 22 is put under tension by pulling on the instrument. Incision and mobilizing the skin is now easy. The mobilized skin is pushed upwards with a sponge, thereby exposing the hemorrhoids which lie on the outside of the instrument. A few fibers which run across these hemorrhoids are loosened and cut. The sphincter externus 46 is now visible. The longitudinal muscle fibers which are attached to the mucosal cylinder 50 are loosened and cut. The sphincter externus 46 is shoved over the sphincter internus 48 like a cuff. The distal part encircles the mucosal cylinder 50 like a ribbon and is also attached to it with muscle fibers. The latter are mobilized and cut. With a sponge the mucosal cylinder 50 is pressed against the body member 12 with the left thumb. The importance of a long body member '12 will now be more apparent. With a sponge in the right hand the sphincter internus 48 is shoved over the mucosal cylinder 50. The border between the mucosal cylinder 50 and the sphincter internus 48 is always visible, thus the shoving up can be done without danger of damaging the mucosal cylinder 50 or the sphincter internus 48.

The great difference between this and other operations, in which the mucosal cylinder is loosened from the sphincter internus with the aid of scissors, is found in this stage of the operation, where the use of scissors is absolutely contraindicated.

The friable mucosal cylinder 50 is firmly protected against damage by the tension over the hard metal body member base 16, and the counterpressure of the left thumb, there where the sphincter internus 48 is loosened from the mucosal cylinder 50.

The external and tortuous, eventually thrombosed internal hemorrhoids 52 are now visible upon the mobilized part of the mucosal cylinder 50. The shoving up of the sphincter internus 48 from the mucosal cylinder 50 is continued until the cylinder 50 appears completely normal. This can be recognized by a pale parchment-like aspect of a thin membrane which now covers the whole mucosal cylinder 50. The distended vessels in the mobilized part of the mucosal cylinder 50 are now visualized beneath this membrane, being normal in form and size, and it is now certain that all hemorrhoids have been loosened.

Up to this stage the operation area stayed sterile because the anal canal was shut off and enclosed by the o'bturo-muco-retractor 10. In the last stage of the operation the skin-edge is attached to the undamaged part of the mobilized portion of the mucosal cylinder 50, which borders on the rim of the sphincter internus 48. This is done by mattress sutures put in at 12, 3, 6 and 9 oclock, whereby bleeding from local mucosal vessels is simultaneously stopped. The partsin between are now sutured likewise. In this final stage only is there possibility of contamination, because the needle and thread penetrate the bowel wall, but this is remote and does not hamper spontaneous healing.

The mucosal cylinder 50 is now cut circularly upon the hard base of the body member 12, somewhat distal of the mucosa-skin sutures. The bleeding caused by this is stopped and following this the obturo-muco-retractor 10 is removed, followed by checking on possible bleeders. In this way hemorrhages and hematomas are excluded and wound trauma is minimized.

As is apparent from the foregoing description, the following advantages are thus obtained. By covering the anal canal contamination is reduced to a minimum. The operation can be anatomically exact. Bleeding during the operation is moderate, due to the cerclage-suture and by the pressure of the instrument, so that the area is dry and clean. Transfusions are not necessary, nor suction, hemostats or cauterization required. No sutures are required for bleeders and therefore no catgut or silk necessary. Sphincter muscles and mucosal cylinder are undamaged.

" Retractors are unnecessary. By pulling on the instrument the whole area becomes visible. By suturing skin and normal mucosa there are no hemorrhages or hematomas. Tedious preoperative procedures, such as treatment with antibiotics or chemical therapeutics are not necessary so that the hospital stay is shortened and economical. Early rectal examination or sounding is painful and hampers healing, and therefore is not necessary in later stages. There can be no "wound infection or premature loosening of the sutures and no rectal stricture.

As is also apparent to those skilled in surgery, my obturo-muco-retractor may be employed in similar fashion for other proctological operations, as have been mentioned earlier, the steps of procedure following those above described and modified according to the nature of the operation performed and recognized procedures and principles.

While I have hereinabove described a preferred embodiment of my invention, and a single operative procedure in which it is employed, it is obvious that various changes may be made in the construction, composition and arrangement of parts by way of modification, within the concept of the invention and the purposes for which it is intended. It is therefore obvious that such embodiment is by way of illustration and not of limitation, and that various changes may be made, as above indicated, without limitation upon or departure from the spirit and scope of the invention, or sacrificing any of the advantages thereof inherent therein, all of which are claimed.

Having described my invention, I claim:

1. An obturo-muco-retractor comprising an elongated cylindrical body member conically tapered at one end and provided with a central cavity in its base,

a shaft axially secured to the body member through its base,

a handle integral with the free end of the shaft,

a cylindrical obturator slidably mounted on the shaft,

a central cavity in the obturator disposed facing the body member cavity and adapted to come in registry therewith to define a mutual cavity,

a coil spring mounted on the shaft with one end of the spring abutting the obturator, and

rotary means, axially moveable along said shaft, abutting the other end of the coil spring and adapted to urge the obturator towards the body member, whereby decreased mucosa is partially caught and held thereinbetween without damage or injury.

2. An obturo-muco-retractor as described in claim 1, the body member and its cavity having the same diameters respectively as the obturator and its cavity at their facing ends to define identical opposing rims for each.

3. An obturo-muco-retractor as described in claim 2, the rotary means to urge the obturator towards the body member comprising an external thread on the shaft, and

a wing nut in engagement therewith.

4. An obturo-muco-retractor as described in claim 3, the body member and obturator rims provided with irregular surfaces.

5. An obturo-muco-retractor as described in claim 4, the body member and obturator rims provided with ridged surfaces.

6. An obturo-muco-retractor as described in claim 4, the body member and obturator rims provided with striated surfaces.

7. An obturo-muco-retractor as described in claim 4, the shaft handle provided with means to support the obturo-muco-retractor in suspension.

References Cited UNITED STATES PATENTS 834,047 10/ 1906 Crumrine 128-3 3 1,344,227 6/1920 Haurnan 128-334 1,918,890 7/1933 Bacon 128-346 2,434,030 1/1948 Yeomans 128-346 2,638,901 5/1953 Sugarbaker 128-334 3,048,177 8/1962 Tararo 128-334 3,168,096 2/1965 Brummelkamp 128-334 3,472,231 10/1969 Niebel et a1. 128-334 FOREIGN PATENTS 1,057,729 5/1959 Germany 128-334C l5 DALTON L. TRULUCK, Primary Examiner US. Cl. X.R. 128-334 

